Abstract The World Trade Center (WTC) attacks caused unprecedented occupational and environmental exposures for hundreds of thousands of individuals. There have been myriad health effects from these exposures, including cancer, respiratory, gastrointestinal, and mental health consequences. The proposed study is based on the scientific premise, that cancer rates are elevated among those exposed to the WTC attacks, as documented by recent findings; however, prostate cancer (PCa) screening, which is elevated in WTC exposed individuals, is not offered through the WTC Health Program (WTCHP). The proposed research provides an opportunity to evaluate an informed/shared PCa screening decision approach for members of the WTCHP. Through three specific aims, we plan to Aim 1: adapt a stepped decision making approach for PCa screening among WTCHP members and train physicians in shared decision making; Aim 2: implement a stepped decision making approach within the Queens WTCHP and identify the proportion of WTCHP who agree to be screened, the psychosocial and demographic factors affecting participants screening decision, and the psychosocial and clinical outcomes of accepting/rejecting PCa screening; and Aim 3: record the cost of implementing PCa screening among members of the WTCHP. We hypothesize that psychiatric morbidity is associated with lower screening utilization, and that screening is associated in the short-term with elevated distress, which will dissipate over time. This study is highly relevant, since PCa is the second most common cancer in the WTCHP, and many of the participants have co-morbidities that can influence their clinical decision making. The use of a informed/shared decision making approach is recommended for PCa screening, and could be applied to screening tests offered within the WTCHP. The investigators are uniquely suited to do this work, with prior expertise in WTC health effects and monitoring and in decision support for PCa. The project is innovative, in that no other WTCHP is using a stepped informed/shared decision approach in clinical care. Cost assessment for future implementation efforts is also innovative. The project is significant, as results have the potential to improve care for the thousands of WTCHP members. This project is also responsive to the participant?s needs, since the request for PCa screening is frequent in the WTCHP. Overall, the proposed project is innovative and significant as it addresses unmet cancer control needs among a highly at-risk population and addresses potential adverse psychosocial consequences of screening efforts.